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GPs go forth

All rise for NICE


What do you think about that new NICE hypertension guidance then? New as in, er, came out in August, but I hadn’t got round to reading it until now.

Let’s face it, you haven’t looked at it either, have you, on account of why on earth would you? In which case, have I got (slightly old) news for you!

Because, buried within NG136, is a gem, which helps resolve two of my biggest chronic disease management bugbears: the patient settling in for a nice comfy chat, and their blood pressure being up.

According to NICE, and obviously I’m never one to question/ridicule/deviate from their guidance, hypertensive patients aged over 80, or with orthostatic dizziness, or with diabetes (ie just about all of them) should have their blood pressure taken standing up.

Joy of joys! So, first, no getting the seat warm. I’ve long advocated consulting standing up as a way of speeding throughput, and this now has the official NICE stamp of approval.

So get rid of those chairs, though possibly not just as your 80-year-old osteoporotic is about to sit down.

For once, NICE, you deserve our congratulations

Even more importantly, standing blood pressure is bound to be lower than sitting.

This means I no longer have to apply Copperfield’s correction factor whereby I subtract 10mmHg from BP readings to take automatic account of the white coat effect (note to GMC: I justify this either because a) I adhere to the basic ethical principle of medicine, ‘first do no harm’, which here I take to include imposing unnecessary medication on a patient, or b) I’m kidding).

Or even, come to that, Copperfield’s advanced correction factor whereby I compensate for unnecessarily lengthy consultations by subtracting 5mmHg from the patient’s recorded BP for every five minutes consulting over the allotted ten.

After all, BP always seems to drop in a linear way on repeated readings during an appointment, doesn’t it?

So long consultations run the risk of the patient’s systolic dropping to a life-threatening zero, which is why I don’t advocate them, though there are some patients I’d make an exception for (further note to GMC: see note to GMC above, subsection b)).

Whatever. What NICE has done, here, is make consultations shorter and QOF targets easier to hit.

Anyone would think it’s Christmas.

So for once, NICE, you deserve our congratulations. I’d suggest a standing ovation.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at or follow him on Twitter @doccopperfield

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Readers' comments (5)

  • naughty

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  • A brave article, I love the correction factor!

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  • I've been doing this for years. It saves you from having to take people off their medications again when they start falling about. An important point is that the arm that the cuff is on should be supported by the other arm so the elbow is at a right angle. If you leave the arm straight down this falsely raises the blood pressure. Also they need to not talk and preferably do the bp before conversing with them much because the more they talk beforehand the higher their blood pressure.

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  • Laughed and laughed and laughed!!!

    'Non medical Mrs' read the article to find out whey I was so unnaturally cheerful. She couldn't see the funny side at all - "isn't it serious when they get dizzy"?

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  • You mean you did not refer to ENT?

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